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The Point - October 3, 2013

In this edition of The Point:


Article #1

Excerpted from “Should Physician-Assisted Suicide Be Legal? Poll Shows Divide Among Experts,” Huffington Post. September 12, 2013 -- Medical experts in the U.S. remain divided in their opinion of whether physician-assisted suicide (PAS) should be legal, a new poll suggests, indicating that the way in which patients die and the role of palliative care will remain issues of much debate. In the poll conducted by the New England Journal of Medicine (NEJM), about 65 percent of votes were against the idea of permitting PAS. The rate among U.S. voters was similar, with about 67 percent voting against PAS. In PAS, doctors provide terminally ill patients with the means to end their own life - for example, giving them a prescription for a lethal dose of medicine, which the patient can later decide whether to take.

Proponents of PAS say that people, in face of an inevitable death, deserve the right to end their lives on their own terms, without pain and suffering. Opponents say that a physician taking a role in a patient's suicide violates a fundamental tenet of medicine by contradicting the doctor's role as a healer. Oregon was the first state to legalize PAS, with the passing of the Death with Dignity Act in 1997. Two other states, Washington and Vermont, followed suit. In 18 U.S. states, a majority of votes supported PAS. Interestingly, the researchers said, Oregon and Washington were not in that group.

More than 200 comments were posted, in which readers made arguments to support their beliefs. Many commentators on both sides of the divide agreed that palliative care, including hospice, are important for helping terminally ill patients manage their pain and suffering, both physical and psychological.


Commentary #1

Family physician, ethics consultant and CMDA Board of Trustees Member Robert E. Orr, MD, CM : “The New England Journal of Medicine recently reported that in its international poll, two out of three physicians oppose the legalization of PAS. They also reported several years ago on a survey of U.S. physicians that gave similar results.1 The good news: (a) most physicians think PAS is a bad idea; (b) the NEJM is willing to report this in spite of their own editorial support of PAS. However, there is also bad news about such polls.

First, it is well documented that the way polling questions are worded can have a significant effect on the results obtained.2 Equally important, poll results may (or may not) reveal what people think about an issue, but they cannot tell us whether the issue in question is right or wrong.

It is possible to effectively speak against PAS using arguments based on principle, virtue or consequences.3 For the believer, there is a strong additional reason to oppose PAS: each person bears the image of God and we must not intentionally end a human life.

Another piece of good news from the poll results is that most people, whether for or against PAS, agree that excellent hospice/palliative care is the preferred response to end of life suffering.4

Bibliography
1Meier DE, et al. A national survey of physician-assisted and euthanasia in the United States. N Eng J Med 1998;338(17):1193-1201
2Hagelin J, et al. Surveys on attitudes towards legalisation of euthanasia: importance of question phrasing. J Med Ethics 2004;30:521-523
3Orr RD. What are the arguments against legalization of physician-assisted suicide and euthanasia? Today’s Christian Doctor 2011;42(2):30-2
4Orr RD. Pain management rather than assisted suicide. Pain Medicine 2001;2(2):131-137


Article #2

Excerpted from “Obamacare May Trigger Exodus of Christian Doctors,” CBN News. October 1, 2013 -- Thousands of Christian doctors across the nation are considering quitting medicine or working overseas because of concerns over the new healthcare law.

Dr. Gene Rudd, senior vice president of the Christian Medical Association, says they're worried they could be forced to facilitate abortions or prescribe drugs that violate their convictions.

Rudd says many of them have avoided hiring and taking on new patients due to uncertainty over Obamacare.

Thousands of the doctors provide care for the poorest areas of the United States and feel called by God to help the sick, but say they need to be able to do so with a clear conscience.


Commentary #2

CMDA Senior Vice President Gene Rudd, MD: “I rarely view or read media reports after I have been interviewed. (In part, this is because someone else at CMDA does that.) But being asked to comment on this article that was based on what I said to a reporter reminded me of how the media uses their perspectives and agendas to create the news. Too frequently I find a failure to report ‘the truth, the whole truth and nothing but the truth.’

“Timed to coincide with the beginning of the enrollment for Obamacare, my interview with this AP reporter covered many perspectives on healthcare reform, perspectives I classified as ‘the good, the bad and the ugly.’ My limited comments about Christian doctors were almost an afterthought. But only those comments made the news.

“Among the many perspectives I cited, one ‘good’ aspect of reform is that some of our neighbors who previously couldn't obtain health insurance coverage would now have some basic level of protection. A ‘bad’ aspect is that now healthy individuals and families who did not have coverage and had little healthcare costs will now have to pay either a penalty for failure to participate or pay premiums. Even with subsidies, one estimate placed the average family premium at more than $5,000. That will be a substantial burden to most family budgets.

“One of the ‘ugly’ aspects of the current reform bill is the permission assumed by the Administration to usurp individual rights and undermine the First Amendment. Already we have seen HHS interpret and implement legislation in a way that attempts to force employers to provide coverage that includes provisions they find morally objectionable. And under the guise of providing required services, we will be required to fund abortions. Only with the use of smoke and mirrors do they attempt to claim otherwise.

“Will reporters continue to filter the news to suit their agendas? Of course. But we will continue to speak the truth in love. Will Obamacare survive? I don’t know. But we will continue to contest provisions that are morally unacceptable and dangerous to our foundation of freedom."


Article #3

Excerpted from “Doctors Look For A Way Off The Medical Hamster Wheel,” Shots: Health News from NPR. August 14, 2013 -- Doctors are on a hamster wheel these days. We're compelled to run faster just to stay in place. It's about to get worse. Obamacare means millions more people will want our services, with not enough primary care doctors to meet demand. Government incentives that are pushing us toward computer-based records mean that doctors now spend as much time documenting our visits with patients as we do examining them.

As the hassles have gotten worse, I've seen many colleagues jump ship. But there might be another way. Dr. Christine Sinsky, an internist in Dubuque, Iowa, has made it her mission to find ways to mitigate the drudgery of modern doctoring. With funding from the American Board of Internal Medicine Foundation, she and four colleagues traveled the U.S. in search of practices that provide top-notch, effective primary care, while making the work satisfying for the doctors and other health professionals. Sinsky and her team found 23 examples of innovative practices from coast to coast, and reported on them in both an academic journal and an in-depth white paper.

Dr. Ben Crocker was so burned out in in 2007 that he lamented, "Working at Starbucks would be better." Now, his practice at Massachusetts General Hospital employs health coaches to work with patients on making the lifestyle changes that doctors recommend but can't adequately teach or monitor. Virtual visits have replaced some in-person visits. Perhaps most incredibly, the practice offers staff downtime each week to come up with innovations.

Sinsky offers examples of tedious tasks that take doctors away from providing undivided attention. No. 1 among them is data entry. "Inbox management" — all the phone calls, emails, forms to sign and prescription refills — can take up to two-thirds of a physician's day. "All of this inbox work can and should be handled by nonphysician personnel, freeing us up," she says. "So many mandatory tasks are crowding out the work of real doctoring.”


Commentary #3

CMDA Member Julie Griffin, MD: -- “Demanding schedules, flawless precision and an enduring calm in calamity—these are expectations of physicians. We have often placed these ultimatums on ourselves with our detailed, driven personalities pushing us to unattainable perfection. Nevertheless, the culture increasingly demands a new maximum.

Hardly imaginable is Hippocrates rushing around the office, then being paged across town for a delivery. Medicine’s revered father never had to defend his decisions to a third-party payer. We prefer the tableau of a wise, forbearing professional to grateful patients and an engaging professor to eager students. In truth, we were in this picture ourselves as we entered medical school.

Have our dreams run amuck? Perhaps, if we lose the focus of our callings in light of career demands. Yet, if we are confident of our callings and moved with the same compassion which moved Jesus (Matthew 9:36), we will not be distracted from our opportunities to serve.

To be sure, we must employ new methods, including delegation of duties. Medicine is moving to team-based care. This change is neither revolutionary nor futuristic. It is an overdue move toward our biblical heritage. Jesus readily embraced teamwork in ministry, and we as physicians should do likewise.

We must remember our calling and the true Strength by which we fulfill it—paperwork, phone calls and all. We cannot be chased out of our ministries for there is no joy or peace in life apart from our appointments as God’s coworkers in the gospel of Christ (1 Thessalonians 3:2-3).

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